Stewart Juhani, Särkelä Mika, Koivusalo Anna-Maria, Wennervirta Johanna, Salmi Tapani, Isoniemi Helena, Stenman Ulf-Håkan, Viertiö-Oja Hanna, Lapinlampi Petteri, Lindgren Leena, Salminen Ulla-Stina, Vakkuri Anne
Department of Medicine, University of Helsinki, Helsinki, Finland; Department of Anesthesiology and Intensive Care, Helsinki University Central Hospital, Helsinki, Finland; Department of Anesthesiology and Intensive Care, Helsinki University Peijas Hospital, Helsinki, Finland.
Liver Transpl. 2014 Oct;20(10):1256-65. doi: 10.1002/lt.23944. Epub 2014 Sep 15.
Acute liver failure (ALF) and hepatic encephalopathy (HE) can lead to an elevated intracranial pressure (ICP) and death within days. The impaired liver function increases the risks of invasive ICP monitoring, whereas noninvasive methods remain inadequate. The purpose of our study was to explore reliable noninvasive methods of neuromonitoring for patients with ALF in the intensive care unit (ICU) setting; more specifically, we wanted to track changes in HE and predict the outcomes of ALF patients treated with albumin dialysis. The study included 20 patients with severe ALF at admission who had been referred to the ICU of the liver transplantation (LT) center for albumin dialysis treatment and evaluation for transplantation. Data were collected from all study patients in the form of continuous frontal electroencephalography (EEG) recordings and transcranial Doppler (TCD) measurements of cerebral blood flow. Among the studied EEG variables, the 50% spectral edge frequency decreased and the delta power increased as the HE stage increased. Both variables were predictive of the stage of HE [prediction probability (PK) of 50% spectral edge frequency = 0.23, standard error (SE) = 0.03; PK of delta power = 0.76, SE = 0.03]. The total wavelet subband entropy, a novel variable that we used for tracking abnormal EEG activity, predicted the outcome of ALF patients treated with albumin dialysis (PK = 0.88, SE = 0.09). With a threshold value of 1.6, the TCD pulsatility index had an odds ratio of 1.1 (95% confidence interval = 0.1-9.3) for a poor outcome (LT or death). In conclusion, EEG variables are useful for the monitoring of HE and can be used to predict outcomes of ALF. TCD measurements do not predict patient outcomes.
急性肝衰竭（ALF）和肝性脑病（HE）可导致颅内压（ICP）升高，并在数天内导致死亡。肝功能受损增加了有创ICP监测的风险，而非侵入性方法仍不完善。我们研究的目的是在重症监护病房（ICU）环境中探索用于ALF患者的可靠的非侵入性神经监测方法；更具体地说，我们想追踪HE的变化并预测接受白蛋白透析治疗的ALF患者的预后。该研究纳入了20例入院时患有严重ALF的患者，这些患者被转诊至肝移植（LT）中心的ICU进行白蛋白透析治疗和移植评估。以连续额叶脑电图（EEG）记录和经颅多普勒（TCD）脑血流测量的形式收集所有研究患者的数据。在所研究的EEG变量中，随着HE阶段的增加，50%频谱边缘频率降低，δ波功率增加。这两个变量都可预测HE阶段[50%频谱边缘频率的预测概率（PK）=0.23，标准误差（SE）=0.03；δ波功率的PK=0.76，SE=0.03]。我们用于追踪异常EEG活动的新变量——总小波子带熵，可预测接受白蛋白透析治疗的ALF患者的预后（PK=0.88，SE=0.09）。TCD搏动指数阈值为1.6时，预后不良（LT或死亡）的优势比为1.1（95%置信区间=0.1-9.3）。总之，EEG变量可用于监测HE，并可用于预测ALF的预后。TCD测量不能预测患者预后。
